\documentclass[green]{NeptuneBall}
\begin{document}
\name{\gRoster{}}

You need to fill out and submit this dance roster to the royal conductor at least {\bf 20 minutes} before the showcase is to begin. \emph{(Find a GM or NPC and give them this sheet.)}\\

\begin{tabular}{| l | c | r | r |}
 \hline
 Dance & Couple  & Lead & Follow \\ \hline \hline
 Swing & 1 & \hspace{4cm} & \hspace{4cm} \\ \hline
 Swing & 2 & \hspace{4cm} & \hspace{4cm} \\ \hline
 Cross Step Waltz & 1 & \hspace{4cm} & \hspace{4cm} \\ \hline
 Cross Step Waltz & 2 & \hspace{4cm} & \hspace{4cm} \\ \hline
 Merengue & 1 & \hspace{4cm} & \hspace{4cm} \\ \hline
 Merengue & 2 & \hspace{4cm} & \hspace{4cm} \\ \hline
\end{tabular}

\end{document}